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AFOLABI Adebukunola Olajumoke, 38 year old registered Nurse, registered midwife, registered Public Health Nurse and Bachelor degree in Nursing Science, Senior Nursing officer at the Labour ward (Maternity Section), Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, South West Nigeria, special interest in Nursing and Midwifery Research. ||  || Introduction The Integrated Maternal Newborn and Child Health(IMNCH) Strategy is Nigeria’s initiative to fast track the achievement of the 4th and 5th MDGs which are concerned with reducing the childhood mortality rate and maternal mortality ratio, by two-thirds and three-quarter respectively while contributing to the achievement of MDGs 1, 6 and 7. The strategy is an integrated approach for the care of mothers, newborn and children in line with the United State Agency for International Development (USAID) Bureau for Global Health’s flagship Maternal, Neonatal and Child Health (MNCH) program, which focuses on reducing maternal, neonatal and child mortality and accelerating progress toward achieving Millennium Development Goals (MDGs) 4 and 5. The IMNCH initiative supports programmes in maternal, newborn and child health, immunization, family planning, malaria, nutrition, and HIV/AIDS.Nigeria’s development of IMNCH is in line with the World Health Assembly’s resolution WHA 58.31, which urges member-states to, among other things; speed up actions to ensure that maternal, newborn and child health interventions are available everywhere. Nigeria however started implementing IMNCH in 2007 when the Federal Ministry of Health of Nigeria (FMOH) developed an Integrated Maternal, Newborn and Child Health (IMNCH).

Why IMNCH is important in Nigeria The strategy in Nigeria is an intervention package that addresses over 90% of the leading cause of Maternal, Neonatal and under five mortality including underlying malnutrition, and HIV/AIDS. The goal of IMNCH: Toreduce maternal, neonatal and child mortality in line with the UN Millennium Development Goals 4 and 5(targeting 75% and 66% reduction in maternal mortality and under-5 mortality rates respectively.
 * Nigeria is Africa’s most populous country, with estimated population at 178,516,904 inhabitants as of 1st July, 2014 (United Nations, Department of Economic and Social Affairs, Population Division).
 * Nigeria has 23% Women of child bearing age, 20% children under five years, Crude birth rate 40. 6 per 1000 and Total fertility rate of 5.7 (NDHS 2008)
 * The country loses 2,300 children under 5 years of age and 145 women of child bearing age everyday to preventable diseases and pregnancy related causes
 * Out of every 5 children born alive, 1 dies before their 5th birthday this represent about 10% of the global total. Majority of these under-five deaths occur at home.
 * Eight out of every ten deaths of children under five are caused mainly by the five most common childhood disorders
 * Annually an estimated 52,900 Nigerian women die from pregnancy related complications (out of global 529,000 maternal deaths).
 * A woman’s chance of dying from pregnancy and childbirth in Nigeria is 1 in 13.
 * Nigeria is the second largest contributor to under five mortality rate (U5MR) and maternal mortality ratio (MMR) in the world.
 * Improving the way pregnant women, newborns and children are cared for at home and in the health facility has far-reaching effects on their health and development in addition to reduction in sickness and death.

Objectives of IMNCH The IMNCH has seven strategic objectives:
 * 1) Improve access to good quality health services
 * 2) Ensure adequate provision of medical supplies, drugs, bundled vaccines, Reproductive Health commodities, and insecticide treated nets and other basic equipment.
 * 3) Strengthen individual, family and community capacity to take necessary actions at home and to seek healthcare in a timely manner.
 * 4) Improve capacity for organization and management of MNCH services
 * 5) Establish a financing mechanism that ensures adequate funding, affordability, equity and efficient use of funds from the various sources.
 * 6) Strengthen supervision, monitoring and evaluation systems to report on progress towards achieving the maternal and child health MDGs.
 * 7) Establish and sustain partnerships to support implementation of IMNCH Strategy

Achievements of IMNCH in Nigeria
 * Reduction in Maternal Mortality Ratio: 545 deaths per 100,000 live births (NDHS 2008) from 800 deaths per 100,000 live births
 * Reduction in Under Five Mortality Rate: 157 deaths per 1000LBs (NDHS 2008) from 201 deaths per 1000LBs
 * Reduction in infant mortality rate; 75 deaths per 1000LBs

Challenges of implementation of IMNCH in Nigeria
 * Insufficient health system capacity
 * Fragmented responsibilities
 * Lack of investment and out-of-pocket expenses
 * Availability and quality of services
 * Access and utilization of services
 * Poor knowledge and practice at house hold level
 * Low Community participation

Current strides in IMNCH to meet MDG targets
 * Improved human resources at PHC level through the Midwives Service Scheme
 * Strengthening supply of RMNCH commodities
 * Health Financing:National Health Insurance and Community Based Health Insurance Scheme in selected states, MDGs Conditional Grant Scheme, Improved budgetary allocation to Health ( from 5% in 2006 to 7% in 2011)

Conclusion There is high level political commitment to improve maternal, newborn and child health in Nigeria, evidenced by the initiation and implementation of health sector reforms. The passage of the National Health Bill in 2015 is a great step forward. The Bill, in addition to defining clear roles and responsibilities for the three tiers of Government and the enactment of the Basic Health Care Insurance Scheme, provides for the establishment of a Primary Health Care Development Fund, with explicit pronouncements on how the funds will be utilized. This will greatly help in putting the IMNCH in place. ||

The increasing Cesarean rate has impacted birth care around the world. In the United States of America the rate is currently 32.8%, down from 32.9 % last year and the first decrease since the new millennium began. The implications of this unprecedented high rate over the last decade on women and children’s health, and the cost considerations make this a very concerning trend. The presentation will discuss the negative aspects of surgical delivery, and suggestions for reversing the pattern of 1 out of every 3 births resulting in a cesarean surgery.